Art & Science Collaborations, Inc. (ASCI) - Art, Science & Technology

Art & Science Collaborations, Inc.(ASCI) - Art & Science - Home

Membership Application Form

After filling-out the form below,
click on the "Confirm" button at bottom.
We can NOT process your membership without this
information being sent to us online.

If you want to PRINT the Membership Form...
click on "print" in right column under Featured Member.

AFTER PRINTING, you must click on "confirm" at the bottom of print form so info goes into our database.

*required fields

First Name* Middle Name

Last Name* Street

City* State*

Zip* Home phone

work phone Email*

Corporate / Institutional affiliation

Will you allow your name + your title/ institutional affiliation to be mentioned in the new/ renewing members section in the ASCI eBulletin?

YesNo

Please choose your membership category. (please send us a copy of your students ID for the students category)*

If you have your own HOMEPAGE, we will link it for FREE at our members Homepages (see "members" on left side bar) URL address:

Six words (max.) to describe your work:
This info is under your name in the ASCI Members Homepage Listing.
(Please mention themes and media you use.)

Your career area:

If you can't find your category in the menu above please enter here:

In order for ASCI to be more helpful to curators, the ASCI members database needs to include information regarding your work. Please choose a category from at least one of the 5 drop down menus below:

ART DISCIPLINES

SCIENCE DISCIPLINES:

TECHNOLOGY DISCIPLINES:

HUMANITIES DISCIPLINES:

OTHER PROFESSIONAL SERVICES:

If you can't find your category in the menus above please enter here:

How did you learn about ASCI? (This is helpful to us!)

Please insert the numbers from the pucture into the following field:

Securitycode:* Securitycode (please insert the numbers from the picture into the following field))

Membership Application Form